e-HealthExpert.org - Primum non nocere

Despite rising investments by venture capital firms, the health IT field as a whole is poised for no more than 5 to 10 percent growth this year, financial analysts who attended a panel discussion hosted by the Nashville Health Care Council this week predicted.

Factors conducive to continued growth include the impending conversion to ICD-10, the analysts said in remarks reported by Healthcare IT News. "I foresee a slightly better 2012, with the emphasis on slightly," said Darren Lehrich, managing director of Deutsche Bank Securities.

John Moore, founder of Chilmark Research, made a similar prediction in a blog post last month. "There will be plenty more [electronic health record] sales in the year to come, but over 2012 we will also see EHR sales growth begin to plateau and level off by end of Q4 '12," he wrote.

The main reason for these forecasts is that EHR sales have been driven by the government's financial incentives. To get that money, physicians and hospitals have to show Meaningful Use; and if they have not already implemented clinical systems, they're unlikely to meet the criteria in time to get the full amount of federal largesse.

However, there are other issues that could affect sales growth of individual companies in the next year or two. One is how much effect the Stage 2 Meaningful Use criteria will have on EHR vendors. If it is difficult to meet the certification requirements in Stage 2, some firms undoubtedly will drop out. That leads to the other question: Will the disappearance many of the current vendors boost sales of the surviving companies?

Even Stage 1 Meaningful Use undoubtedly has increased the big vendors' sales as physicians with minimal EHRs converted to more capable systems. But the market has already consolidated to some extent. Five vendors accounted for more than half of the Meaningful Use attestations last year, and some observers think that fewer than 10 companies own most of the market. If that's the case, the disappearance of many smaller firms won't have much impact on the survivors.

Nevertheless, venture capital firms see gold in health IT. They poured $633 million into the field last year, InformationWeek Healthcare reported. That was the highest amount since 2001, when they invested $759 million.

To learn more:
- read the Healthcare IT News story
- watch this video recap of the event 
- see the Chilmark Research blog post
- check out an InformationWeek article on venture capital investment
- see an article on Meaningful Use attestation

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Some hospitals pay thousands of dollars more than others for big-ticket medical devices, according to Government Accountability Office (GAO) investigators, The Wall Street Journal reported.  From defibrillators to hip replacements to drug-eluting stents, a portion of those higher costs are coming out of Medicare's pockets.

The report released today surveyed 31 hospitals and found, for example, that one hospital paid $8,723 more than another for an identical implantable cardioverter defibrillator, which typically costs between $16,445 and $19,007. The cost of stents varied by as much as $828 from the typical cost of $1,700 to $1,800 each.

The report "raises serious concerns over the prices hospitals and Medicare are forced to pay for implantable medical devices," said Montana Democrat Max Baucus, chairman of the Senate Finance Committee, who requested the GAO study.

The GAO report says lack of price transparency hampers hospitals' ability to be "prudent purchasers" of medical devices.

Device makers say their products represent only a small portion of the $2.8 trillion in annual health spending and that greater savings could be found elsewhere, according to WSJ. Although confidential price agreements are in part to blame, price transparency could increase costs by discouraging sellers from offering discounts, David Nexon, an executive vice president of the Advanced Medical Technology Association, a device trade group, told WSJ.

Drivers of medical device costs includes healthcare organizations' desire to look better than competing hospitals, as well as doctors who demand hospitals provide them with specific devices, even if identical but less-expensive models are available. The GAO report highlights that latter problem and said contracts between manufacturers and hospitals often forbid price disclosures even to doctors, making it harder to steer doctors to less-expensive options, according to WSJ.

In some cases, hospitals bound by such contracts resorted to using color-coded stickers to help doctors distinguish between cheaper or more expensive devices on stock shelves, the report said.

To learn more:
- read the WSJ article (subscription required)
- see the GAO report (.pdf)

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Computerized tests used to determine whether football players and other athletes can return to competition following a concussion aren't always reliable and arguably are relied upon too much, a study published this week in the Journal of Clinical and Experimental Neuropsychology concludes. The study's authors, according to an announcement, find that some tests don't measure functional and metabolic impairments of the brain. What's more, cognitive performance measured by the most scientifically-validated of the tests currently being used--Immediate Post-concussion Assessment and Cognitive Testing (ImPACT)--usually normalizes within three weeks of a concussion, according to the authors, but that doesn't necessarily mean the injured athlete being tested is fully healed. Additionally, they say, such tests can actually harm recovery. Announcement

The intrepid hospital and physician office pioneers leading the charge toward accountable care organizations have learned some key lessons about IT--its role, its limitations and its challenges.

A recent article published in Health Data Management delves into the topic with gusto. It covers a lot of ground, but for CIOs, there are some specific, important tips worth following to help as you evaluate the ACO path for your own institutions, including:

Data exchange: You can't do without it: The Northern Adirondack Region Medical Home Project, based in Plattsburgh, N.Y., has connected electronic health records for its 26 group practices, five hospitals and nine payers to a statewide regional data exchange, according to the HDM article. The EHRs do some of the heavy lifting--allowing doctors to order lab tests, view results and prescribe meds. But the data exchange helps docs keep track of their patients outside their own practice, giving them access to hospital discharge summaries, ER visit records, and medication lists from other providers, the story explains.

It's a daunting task, though, and one that took more than 18 months to get all the interfaces built, testing completed, and bugs worked out.

Data exchanges can have unexpected benefits, too. For example, health information exchange group Michigan Health Connect has turned its data exchange into a central communications/referral hub, HDM reports. More than 200 physician offices are tied into the system, and using referral forms the HIE added to the platform, they now can search for referring physicians, and even complete and forward the referral paperwork online.

Technology needs to automatically update MDs on patient admissions: Any worthwhile ACO will have to give physicians tools to know where their patients are receiving care. In particular doctors need to be notified immediately when a patient presents at the emergency room, so they can help manage the incident. Cox Health Plans, which has applied to participate in an ACO-like bundled-payment program under Medicare, is testing out a "virtual hub" technology for just this purpose, alerting physicians to ongoing exacerbations, HDM reports

Vendors, payers may not be on board: The biggest IT obstacle to an ACO's technology progress isn't always the hospital's budget. In some cases, proprietary vendors aren't willing to put in the time or money to interface or integrate their systems with other multi-system exchanges. Heidi Moore, a member of the Northern Adirondack project's executive board, admits her practice's primary EHR vendor wouldn't create an interface to the state HIE. The result: "Our former vendor had no national vision," she tells HDM. "We had to make a horribly difficult choice to drop them."

Payers, too, may be late to the ACO party, technologically speaking. Our sibling publication, FierceHealthPayer revealed a few weeks ago that insurers are years behind in upgrading their core IT systems. A new study showed that while half of payers want to participate with new business models like ACOs, more than three-quarters say they can't do it from a technology standpoint. 

Home monitoring tops IT wish lists: One big technology gap that could sink ACOs is at-home monitoring of chronically ill patients, Jim Adams, managing director of The Advisory Board, tells HDM. In particular, it will make patients more accountable for following their treatment protocols, and adhering to diet, medication or other regimens--all of which are important to keep outcomes high. "Accountability will be pushed out to the patients," he says.

For just this purpose, Richard Lopez, CMIO for Massachusetts ACO Atria Health, recommends ACOs include a patient portal where patients can request prescriptions and appointments and view lab results--all as ways to keep them engaged in their care. 

To learn more:
- read the Health Data Management article

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After more than a year of development, a group of business students at University of California, Merced, are launching the first test of their Valley Telehealth Program.

The pilot will focus on women with gestational diabetes in the Central Valley region of the state. Overall diabetes rates there are 9.4 percent, several points above the 7.8 percent average for the rest of the state, according to a report in CaliforniaHealthline.

The project is starting in Dos Palos, a small town near Merced, Calif. Study participants will be given at-home glucose monitors that can transmit their testing results to physicians. They'll also have e-visits with physicians, including specialists, about gestational diabetes, diet, nutrition and other topics, rather than traveling the 30 miles or more to the physician's office.

There certainly is precedent for telehealth to shave costs for diabetic patients. We reported on a study in the journal Health Affairs last fall that found telehealth interventions, substituted for clinic-based care, cut costs an average of eight to 13 percent.     

Another, far larger, study in the U.K. showed that telehealth could cut ER visits by 15 percent, and ER admissions by 20 percent. 

Data from a pilot in Oregon found reducing a patient's need for transportation to and from physician visits, is low-hanging fruit for a telemedicine program. That state's OHSU Telemedicine Network reported saving patients and insurers $500,000 in transportation costs over a two-year period.

Interestingly, the VTP program isn't being run by a healthcare organization, but by business students with the university chapter of Students in Free Enterprise. SIFE is a global nonprofit organization that encourages its students to use business concepts to create sustainable projects for underdeveloped regions of the world, according to Healthline.

If the pilot succeeds, students plan to expand it to the entire Central Valley. "The statistics in the Central Valley are comparable to a third-world country," Jared Calinisan, a UC-Merced business major and SIFE project manager, tells Healthline. "By targeting [these] patients and helping them prevent those complications, it also cuts down on fees for hospitals."

The pilot is working through regional medical centers Mercy Medical and Merced Diabetes Center. At least six other hospitals in the Valley have been set up with high-speed connections and telehealth equipment, however, and may ultimately join in the larger project. 

To learn more:
- read the CaliforniaHealthline article
- get more detail from the VTP website 

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The Cleveland Clinic goes straight to the front of the class for its website--but Mayo Clinic gets it knuckles rapped. 

In a "website smackdown," Inc. magazine examines the online presence of two healthcare giants and finds that one "understands its target audience and serves that audience's needs extremely well [while] the other just doesn't get it."

The article is a good reminder that healthcare organizations must design websites for their customers--not for themselves. Although hospitals and health systems often highlight information about world-renowned research, details about fancy imaging and robotic technology, or photos of beautiful buildings, site visitors are much more likely to be looking for quick answers to key information, such as phone numbers, directions and visiting hours.

Rochester, Minn.-based Mayo Clinic falls down in this category, Inc. notes.

"There is virtually nothing on the homepage that is designed to help patients, families of patients, or people looking for assistance from the hospital," the article says. "After much searching, you can find (in a tiny font and in a sub-navigation) 'Request an Appointment' and 'Find a Doctor.' What you won't find is a phone number, directions, or anything else that might be of real use."

Ouch.

The primary navigation on the Cleveland Clinic site gets much better marks for clearly leading visitors to contact information, locations and directions, doctor search, appointments and patient and visitor information, Inc. says.

Ohio-based Cleveland Clinic emerges the winner in health information and find-a-doctor features, as well.

Inc. magazine's opinion notwithstanding, both organizations are well-regarded in the healthcare field for their efforts in online communications, including social media.

Earlier this year, Mayo Clinic, which has its own social media network and has hosted three annual healthcare social media summits, earned the top spot on a list of 20 healthcare organizations with "inspiring" social media strategies.

But the two clinics are hardly the only healthcare organizations to get poor marks for website design.

A recent study by The Journal of Healthcare Management, for example, assessed U.S. hospital and health system websites' performance based on accessibility, content, marketing reach, technology, design and maintenance--and found them wanting.

The mean overall score for the U.S. health systems included in the study was 6.37 on a 10-point scale, indicating that hospital and health system websites have significant room for improvement, Eric Ford, the Forsyth Medical Center distinguished professor at the University of North Carolina-Greensboro and one of the study's authors, wrote.

Neither Mayo Clinic nor Cleveland Clinic made it into the study's list of the top nine sites.

To learn more:
- read the full Inc. magazine comparison of the Mayo and Cleveland Clinic websites
- see the Eric Ford's healthcare website research summary
- learn more about 20 hospital and health system social media strategies

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In describing ICD-10 for a recent Hospitals & Health Networks commentary, Albert Oriol, chief information officer at Rady Children's Hospital San Diego, says that healthcare executives "only wish" the process was comparable to the buildup of Y2K. "Unlike Y2K ... the effort isn't relegated to the IT back office. This time, massive education will be required of IT's customers along the revenue cycle, which, let's not forget, begins with clinical documentation." Regardless, Oriol recommends taking a positive approach to the implementation. "Call me a control freak, but I'd rather get the pieces we can control in order," he says. Commentary

Despite the complexity associated with computerized physician order entry, such systems can be used on a broad scale by medical facilities to schedule medical imaging exams, a new study focused on such efforts at Boston-based Brigham & Women's Hospital concluded. What's more, if properly used, CPOE can decrease inappropriate use of imagining while boosting the quality of patient care, according to the study's authors.

Published in this week's Journal of the American College of Radiology, the study examined the use of CPOE at the hospital from its initial implementation in 2000 through 2010. Of 4.1 million imaging studies performed over that time period, 94.6 percent originated from CPOE, the study's authors found.

Adoption was highest among dermatology specialists at 99.2 percent. Additionally, 99.2 percent of doctors in an emergency setting adopted CPOE. Cardiologists had the lowest adoption rate at 90.8 percent.

CPOE was most used for CT and MRI exams, the authors also noted. Success of the system was due primarily to "usability accessibility and reliability," they added.

"Our results suggest that with adequate IT integration and workflow optimization, we can engage providers in all care settings or specialties with CPOE for imaging ... to create an opportunity for [decision support] to improve quality, safety and reduce waste," the authors said.

Future implementation, the authors noted, is likely to be quicker and easier, considering that hospital employees today are more technology proficient.

To learn more:
- read the study's abstract
- check out this AuntMinnie.com article

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The U.S. Department of Health & Human Services is making "significant progress" toward new and revised rules that would save the healthcare industry billions of dollars, including ones that will address privileging and credentialing and documentation regulations for both in-person and telemedicine visits, the agency reported.

Many of the rules--both proposed and final--increase efficiency and alleviate administrative burdens on physicians, HHS wrote in its most recent update.

HHS reported on health IT-related efforts, including a proposed rule that would allow patients to more easily access their clinical lab test results, and two that would affect telemedicine programs.

One would revise the Medicaid home health service definition under the Affordable Care Act to add a requirement that physicians document face-to-face encounters, including those conducted using telehealth technology, with the Medicaid eligible individual within specified timeframes. HHS says this rule would save an estimated $1.2 billion by 2019.

The second rule, which has already been finalized, revises the conditions of participation for hospitals and implements a new credentialing and privileging process for physicians and practitioners providing telemedicine services.

"This specific reform is estimated to result in $13.6 million savings to hospitals per year," HHS reported. "These revisions will provide more flexibility to small hospitals and [critical access hospitals] in rural areas and regions with a limited supply of primary care and specialized providers. Hospitals and CAHs will support this as it reduces the burden associated with the credentialing and privileging process."

Meanwhile, at a meeting of the National Rural Health Association (NRHA) this week in Washington D.C., members made a series of recommendations and statements about reimbursement for telehealth.

Among them:

• Reimbursement for services provided through telehealth should be made based upon medical effectiveness and utilization and not based upon or limited to particular delivery platforms or locations.
• The Medicare law should be expanded to allow anything currently covered by Medicare to be reimbursed when provided through telehealth by appropriately licensed or credentialed providers otherwise eligible for Medicare reimbursement.
• A telemedicine payment methodology should be provided so that a professional fee is paid to all providers necessary to that particular encounter, including a technical fee to the facilities to cover costs associated with the technology at rates to be determined by the HHS Secretary.
• A separate Medicare billing code for telehealth consultations should be implemented to assist in monitoring the use of telehealth.
• A federal policy should be adopted to allow telemedicine providers to receive deemed status and to allow for healthcare facilities receiving telehealth services to perform credentialing by proxy. If a provider is already credentialed at a Medicare participating facility, that credential would be sufficient for providing telemedicine services at another facility.

HHS also made note of a review that's underway of a Food and Drug Administration rule for medication bar codes. Under the current rule, drug manufacturers must use a certain type of bar code to identify the drug, but since that rule was imposed, many more types of bar codes and bar code readers have hit the market.  FDA will conduct an economic review to determine if the rule should be modified to include these new technologies, according to HHS.    

To learn more:
- here's an overview of HHS' retrospective review project
- read HHS' January retrospective review report (.pdf)
- see a chart listing all of HHS' proposed and final rules (.pdf)
- read the American Hospital Association summary of the report
- read NHRA's health IT recommendations

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Massachusetts legislators are voting today on a bill to require physicians to check a prescription-drug abuse database before prescribing pain meds. It's part of a larger statewide effort to rein in rampant prescription drug abuse in the state, according to a report in the Boston Globe.

The state has had the online database for two years, but only a fraction of the tens of thousands of Massachusetts physicians have registered to use it, the Globe reports. The database was created to alert physicians to patients who might be "doctor-shopping" to obtain opiates and other high-risk prescription drugs.

The bill would require about 30 percent of physicians--those who write a majority of the prescriptions for narcotics in the state--to register with the site by Jan. 1, 2013, with the rest registering at their next license renewal.

Massachusetts has one of the highest rates of narcotics abuse in the nation, particularly with powerful opiates like Oxycontin and heroin, according to WBUR News Service. Hospitalization rates for opiate users, not including heroin, jumped by more than 600 percent from 1998 to 2008, the Globe reports.

For that reason, doctors aren't the only ones authorized to use the database. Public health agencies and law enforcement, too, can access the information to investigate fraud and other illegal activity, according to an Associated Press report.

Massachusetts isn't the first state to take such a firm stance on the issue. Tennessee already has a similar database, and senators there are pushing bills to require physicians to check the database for every patient and to upload prescription information every 24 hours. Also, New York's attorney general recently called for the state to create a prescription-monitoring database.

To learn more
- check out the Boston Globe's report
- get more detail from the Associated Press
- read the WBUR coverage

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Health and fitness apps and websites may be getting a bad rap these days, with many viewed as ineffective and unlikely to help users achieve long-term results. But add a "virtual coach" and you may boost effectiveness, according to a new study in the Journal of Medical Internet Research, conducted by Partners' Center for Connected Health in Boston.

The 70-patient study tested the value of a virtual coach, an "automated, animated computer agent" installed on participants' home computers to provide personalized feedback to users, researchers said. The nonhuman avatar engages directly with participants, carrying on five- to 10-minute semi-scripted conversations to encourage good behaviors and help participants set incremental goals and devise motivational strategies.

The conversations with the coach were tailored to each participant, with the coach's responses based on whether the participant had met exercise goals (according to data from a study-provided pedometer), complied with their diet for that day, or asked for help on a particular issue, according to the study.

"Virtual coaching has many applications beyond promoting activity and is increasingly recognized as an important component in the management of chronic conditions, such as diabetes and heart disease, and in the promotion of healthy behaviors, such as adherence to medication," center director and study co-author, Joseph Kvedar, said in a statement this week.

The coach's primary value seems to be in keeping participants engaged with the exercise program, the study found. Although participants working with a coach didn't walk more that those that did not, they did maintain a steady step count of about 7,000 per day throughout the 12-week study. Participants who didn't have a virtual coach saw their step count gradually fall off from about 7,100 to 6,100 per day.

One of the study's weaknesses is its reliance on desktop computers, researchers admitted. "Equitable access to technology is still a further concern, as groups most affected by obesity, such as minorities and low-socioeconomic status groups, are least likely to have access to technology," they wrote. With that in mind, researchers recommend creating a mobile virtual coach for cell phones.

Virtual coaching also may require more technical support for users, researchers noted. Study participants using the virtual coach made about 40 percent more requests for technical assistance that participants in the control group, who only used a pedometer and website.

To learn more:
- read the JMIR study
- check out Partners' announcement (.pdf)
- get more detail from mHIMSS article

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The Medical Group Management Association (MGMA) sent the Centers for Medicare & Medicaid Services (CMS) a letter complaining that physician practices are having trouble getting paid because of the transition to the HIPAA 5010 electronic transaction set, which went into effect on Jan. 1. MGMA demanded that CMS take action to prevent further disruptions to physicians' cash flow.

"Should the government not take the necessary steps, many practices face significantly delayed revenue, operational difficulties, a reduced ability to treat patients, staff layoffs, or even the prospect of closing their practice," MGMA wrote. "As the transition to Version 5010 is a mandatory step toward ICD-10 implementation, this raises even more concerns, understanding the magnitude of ICD-10 is exponentially greater than Version 5010."

The reference to ICD-10 comes just a week after the American Medical Association sent a letter to House Speaker John Boehner asking him to stop the implementation of the ICD-10 diagnostic code set, scheduled for Oct. 1, 2013.

While MGMA has not called for ICD-10 to be terminated or postponed, it did reiterate its request to CMS to delay enforcement of the 5010 transaction set until June 30, 2011. Previously, CMS said it would not enforce the use of 5010 until the end of March because many providers were unprepared for the Jan. 1 deadline.

MGMA described a number of problems that have resulted in physicians not getting paid by commercial and Medicare carriers. Many practices said they had tested 5010 claims successfully with insurers, but their claims were rejected after they went into production mode. The letter also listed technical issues that resulted in claims denials, such as address problems and non-recognition of NPI numbers.

Government payers, ironically, have been the worst offenders. MGMA said Medicare and TRICARE had not paid many practices since last November.

Besides asking for the deadline extension, MGMA requested that CMS:

• Instruct Medicare carriers to make "advance payments" to physicians struggling to submit 5010 claims
• Permit clearinghouses and health plans to accept and adjudicate 5010 claims that do not have all of the required data content, but that have sufficient data content to be successfully adjudicated.
• Order Medicare carriers to adjudicate claims more quickly, accept claims in batch mode, and answer provider questions in a timely manner.

Meanwhile, in a Health Data Management article, Jackie Griffin, client services director at Gateway EDI, said many providers are experiencing difficulties in getting their claims paid as a result of the 5010 transition. But she counseled patience as the industry works its way through implementation of the new standards.

Here's what Griffin recommended:

• Know what new elements are required for 5010 claims and provide them. Otherwise, the clearinghouse can't help you.
• Monitor your rejections both at the EDI and EOB levels so you can address the issues identified in those claims.
• Network with other practices in your specialty to learn from their experience.
• Keep in touch with what industry associations are saying about the 5010 transition.

To learn more:
- read the MGMA letter
- read Griffin's article

Editor's note: FierceHealthIT is hosting a breakfast panel discussion on ICD-10 preparedness on Feb. 22 at the HIMSS conference in Las Vegas. Executives from leading healthcare organizations will share what they're doing now to ensure a smooth--and even profitable--transition to ICD-10. For more information and to register, visit the ICD-10 Readiness for Hospital IT Leaders: Lessons Learned from the Trenches website.    

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Information silos in healthcare settings are a primary reason why available data often isn't used to its fullest potential, concludes Russ Richmond, M.D., CEO of McKinsey Healthcare's Objective Health consulting firm, in a new post that appears on The Health Care Blog.

Such a failure to "connect the dots" Richmond says, can be detrimental to boosting the quality of patient care.

In contrast to datasets used by health payers, hospital data is much more fragmented and complex, Richmond says. That, in effect, limits the number of entrepreneurs willing to tackle data flow issues, leading to what Richmond calls a "stifling of innovation."

Richmond is not alone in his assessment. An article published last month in the Wall Street Journal points out that while healthcare is "the next frontier" for big data, its acquisition historically has been a "problematic" one.

While Ben Rooney, the article's author, doesn't focus as much on the struggles of hospitals to use such exorbitant amounts of data, he points out another problem. "[Data] is wrapped in layers of regulations and stringent safeguards and is expensive to collect," he writes.

To remedy such issues, Richmond says that hospitals need to be flexible in their decision-making processes. "We are still seeing hospitals continue to over-emphasize the collecting of information rather than carefully analyzing those data to create insights that truly matter," he writes.

To learn more:
- read Richmond's post
- here's the Wall Street Journal article

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Healthcare organizations need to "serve as their own watchdog" to increase security and decrease data breaches, a new report from IT security audit firm Redspin concludes. The increase in "bring your own device" policies at various hospitals, in addition to the continued implementation of electronic health record systems, are too much for government alone to regulate, the report's authors say.

The report digs into the latest major data breach figures--those breaches impacting 500 or more individuals--released by the U.S. Department of Health & Human Services' Office for Civil Rights. With the addition last week of the 2011 Sutter Health breach, which impacted 4.2 million patients, the number of major healthcare information breaches now sits at 385 since 2009.

"The Federal government is unlikely to mandate that all portable devices that store [electronic personal health information] be encrypted, but it's an obvious and sensible policy for a healthcare organization to adopt," the authors say. "Taking it further, why not require that all mobile devices in the healthcare workplace be encrypted, even if ePHI is not allowed on them?"

According to the report, nearly 40 percent of all major PHI breaches occurred on a laptop or other portable media device, a problem the authors say isn't likely to go away anytime soon. "Portability is here to stay," the write. "The BYOD revolution is well underway, yet 50 percent of respondents in a recent healthcare IT poll say nothing is being done to protect data on those devices."

In the last year alone, data breaches stemming from employees losing unencrypted devices spiked a whopping 525 percent, according to the report. Total records breached in that same span nearly doubled (97 percent), increasing the average number of patient records per breach from nearly 27,000 to more than 49,000.

"[I]t is strikingly clear that woefully inadequate security risk analysis [if any] took place prior to the occurrence of these incidents," the report's authors write. They add that a "proper risk-based assessment" could have triggered an evaluation of security controls in place at the time, given the large amount of PHI involved.

To learn more:
- here's Redspin's announcement
- download the report (registration required)

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Two health IT startups aim to help patients sift through the reams of adverse event data collected by the U.S. Food and Drug Administration, according to a report today in the Wall Street Journal.

The two companies, AdverseEvents and Clarimed, have developed websites backed by algorithms that sort FDA adverse event reports, streamline the data, back out misspellings or inaccuracies, and make it easier for consumers to understand FDA's findings.

AdverseEvents provides an online search process for FDA's adverse event reporting system (known as AERS), and covers about 4,500 medications now on the market. Clarimed does essentially the same thing, but for the 130,000 medical devices listed in the FDA's Manufacturer and User Facility Device Experience (also known as MAUDE), the Journal reports.

The basic search is free, but AdverseEvents is planning to launch a new fee-based service this week, charging users $10 per month for more detailed information and reports. And Clarimed may soon do the same, according to the Journal.

Clarimed founder Nora Iluri compares her service to the J.D. Power and Associates safety ratings for cars. "Suddenly, manufacturers started competing on quality. The best way to drive quality improvements is to make things crystal clear and transparent as possible," she tells the Journal.

However, there are caveats. Experts note that FDA's data can't parse out when a severe side effect is actually due to the drug itself, another contra-indicated medication, or just sheer coincidence. And with medical devices, its databanks can't clearly indicate the effects of operator error or other non-device-related factors.

The numbers also have little context, the Journal notes. For example, the FDA data doesn't indicate the overall use levels of any particular drug. So, a drug like Lipitor may have a larger number of adverse events than others in its class, such as Crestor, because it is prescribed far more often, not because it is more dangerous.

Still, experts say AdverseEvents and Clarimed can be helpful. "If you just want an impression of the side effects of a drug, those impressions are pretty accurate," Thomas Moore, a senior scientist at the Institute for Safe Medication Practices, tells the Journal.

To learn more:
- read the WSJ article
- here's some history on Clarimed

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Health intelligence firm Leavitt Partners--which was founded by former U.S. Department of Health & Human Services Secretary Michael Leavitt--announced this week the creation of its "FuturePanel," a group of healthcare thought leaders that will serve as an advisory board to the firm. Aside from Leavitt himself, several former officials both from HHS and the Centers for Medicare & Medicaid Services will serve on the panel, including former CMS acting administrator Charlene Frizzera, former HHS assistant secretary for legislation Vince Ventimiglia and former CMS chief medical officer Barry Straube. Former American Medical Association CEO James Madara also is a member of the panel. The firm serves as a consultancy for hospital systems, insurance companies and medical device firms. Article

The U.S. Department of Health & Human Services recently created a new online toolkit bringing a host of federal resources into one place. The goal: To give rural providers easier access to federal programs that can help them improve overall IT systems, as well as implement electronic records and reach Meaningful Use goals more quickly.

The toolkit, co-developed by the Rural Assistance Center and the National Rural Health Resource Center, shows rural providers:

• Where to find funding: The site lists a host of lesser-known federal grants and loans that rural hospitals may be eligible for, plus it provides some guidance on how to apply. For example, rural providers can be reimbursed for some of their telecom and Internet service costs through the Rural Health Care Program Universal Services Fund.
• How to get started: The toolkit includes workflow designs, strategic plans, project checklists, a cost/benefits database, and readiness assessments--many of which have been used in live IT projects in the field.
• What mistakes to avoid: The toolkit provides case studies on implementations around the U.S., as well as contact information for regional extension services, which providers can tap for in-person, on-site technical assistance.

"A lot of rural providers need guidance on putting an HIT system in place," National Rural Health Resource Center Executive Director Terry Hill said, according to an announcement. "This toolkit gives them a starting point and can help them get through the entire implementation process."

To learn more:
- read the RAC announcement
- check out the RAC toolkit website
- read the iHealthBeat article

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John Halamka, CIO of Beth Israel Deaconess Medical Center (BIDMC) in Boston, had a personal experience recently that showed why the Digital Imaging and Communications in Medicine (DICOM) standard for transmission of medical images is not sufficient when it comes to cross-organization information exchange.

In a recent blog post, Halamka explains that his wife Kathy needed a follow-up visit following a breast cancer exam, and wanted to send her mammogram from her local hospital to BIDMC. It turned out that the only way to do it was to pick up a CD that contained the mammogram and the correct viewer and physically take it to BIDMC herself.

Halamka says that DICOM was created to move images across radiology systems within an organization. However, he said, "It is not sufficient for a healthcare information exchange world that uses the Direct implementation guide ... for content exchange among organizations. The fact that vendors such as LifeImage, Accelarad, and Merge Healthcare have created their own image sharing networks suggests that more standards work is needed to create an open ecosystem of image sharing among organizations."

Here's what would be required to create a true image-sharing capability that would eliminate physical transportation of storage media, according to Halamka:

• A DICOM implementation guide to mandate vendor-neutral content in imaging messages--including a basic set of metadata that would work with any viewer (Siemens, Afga, Philips, GE, Kodak, etc.).
• That vendor-specific/proprietary data be stored separately from vendor-neutral content, so that proprietary extensions of DICOM would not impede generic viewers.
• EHRs with vendor-neutral DICOM viewers being all that a clinician needs to receive and view images. No organization should be required to have a Picture Archiving and Communications System (PACS) for clinicians to view images sent by another organization.

Halamka promises that the Healthcare IT Standards Committee, a federal advisory body, will take up DICOM standards in its spring session. Of course, he can carry out that commitment, since he's co-chair of the committee.

To learn more:
- read Halamka's post
- here's his previous post on DICOM

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After warning Congress that some medical devices were being approved despite possibly posing a danger to patients, a number of scientists and doctors had their personal email secretly monitored by the U.S. Food and Drug Administration, according to the Washington Post. Six of those scientists and doctors filed a lawsuit last week against the agency after all were either harassed or fired. Among other responsibilities, the affected employees were responsible for reviewing cancer screening devices, the Post reported. Article

Chief medical information officers earn, on average, between $200,000 and $300,000, according to CMIO magazine's 2012 Compensation Survey. But fewer CMIOs are making that rate now (43 percent) than they did in 2010.

The discrepancy is making CMIOs a bit disgruntled, as nearly 25 percent of respondents indicated dissatisfaction with their salaries, up from just 19 percent in last year's survey.

One reason may be the changing role of the CMIO. "Some CMIOs are now being held accountable for the fiscal responsibility of attaining the Meaningful Use dollars that organizations are counting on to contribute to their bottom line," Maureen Gaffney, CMIO for Winthrop University Hospital in Mineola, N.Y. told CMIO. "This is new ground for CMIOs."

Other interesting findings from the survey included:

• More women are becoming CMIOs: Female CMIOs now make up 13 percent of the profession, up from only 8 percent in 2010.
• More CMIOs expect to earn bonuses this year: The numbers aren't huge, but 24 percent expect to receive a bonus this year of 1 to 2 percent, while 27 percent say they'll be getting a 2 to 4 percent bump. Those numbers are up from 20 percent and 25 percent, respectively, in 2010.
• CMIOs are getting younger: The demographic skewed downward this year, to 40 percent (the largest group) between 41 and 50 years old. Last year, the largest group was 51 to 60.

"This is definitely an attractive role for those who are younger," Brian McDonough, CMIO at Wilmington, Del.-based St. Francis Hospital told the magazine. "For those who are young and familiar with technology, there is an opportunity to take an active role in improving the quality of patient care."

What's more, most CMIOs are maxed out. Only about a quarter of respondents said they expected their CMIO workload to increase in the year ahead.

This surprised Donald Levick of Lehigh Valley Health Network in Allentown, Pa., who said "with ICD-10, meaningful use, and ACOs [accountable care organizations], a lot of pressure is being placed on the clinical information systems, and therefore, the CMIO."

"However," he added, "it's possible that respondents already have experiences increases in their workload and are now just maintaining that high level."

To learn more:
- here's the CMIO survey

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